Z-Codes as a Social Determinant of Health Screening Tool for Perioperative Risk Stratification in Total Hip Arthroplasty.

BACKGROUND

Social determinants of health (SDOH) substantially influence surgical risk. However, International Classification of Diseases, Tenth Revision Z-code documentation as a perioperative screening tool for patients undergoing total hip arthroplasty (THA) has not been examined using electronic health record-integrated data. This study aimed to analyze the association between documented SDOH-related Z-codes and postoperative complications following primary THA.

METHODS

Using a national database, patients who underwent primary THA with minimum 2-year follow up were stratified by the presence or absence of SDOH-related Z-codes documented prior to the index procedure. Patients were propensity-matched at 1:1 to controls, adjusting for demographics and comorbidities. In total, 2,460 propensity-matched patients (1,230 per cohort) were analyzed. The primary outcomes were periprosthetic joint infection (PJI) and revision THA. Surgical outcomes were assessed at 90 days, one year, and two years. Risk ratios (RR) with 95% confidence intervals were calculated with P-values <0.05 considered statistically significant.

RESULTS

At 90 days, primary surgical outcomes did not differ significantly between cohorts. Patients who had SDOH demonstrated significantly higher rates of emergency department visits (RR, 1.95, P < 0.001), readmission (RR, 1.70, P < 0.001), and acute kidney injury (RR, 1.63, P = 0.011). At one year, PJI rates were significantly higher in the SDOH cohort (3.90 versus 2.44%; RR, 1.60, P = 0.038). At two years, PJI (4.55 versus 2.60%; RR, 1.75, P = 0.009), revision THA (3.66 versus 2.20%; RR, 1.67, P = 0.031), and periprosthetic fractures (2.60 versus 1.38%; RR, 1.88, P = 0.030) were significantly elevated in the SDOH cohort.

CONCLUSIONS

This study supports Z-code documentation as a clinically actionable perioperative screening tool for primary THA patients. The progressive emergence of surgical complications in patients who have SDOH Z-codes highlights the importance of sustained postoperative surveillance and dedicated perioperative interventions for this vulnerable population.